MIDTERM OUTCOMES OF AORTIC VALVE SURGERY THROUGH A RIGHT ANTERIOR SMALL THORACOTOMY(RAST)

L. PASSOS, T. AYMARD, R. CORTI, P. BIAGGI, J. GRUENENFELDER, D. RESER 
DEPARTMENT OF CARDIAC SURGERY, HERZKLINIK HIRSLANDEN

INTRODUCTION

Aortic valve surgery through a right anterior small thoracotomy (RAST)has become a standard of care in cardiac surgery at specialized centres. Ten years ago, we have established a structural heart-teamcenter where we discuss every valve case in order to offer patient tailoredtherapies (surgery versus interventional). The aim of our study was to analyzethe outcomes of our singler-centerheart-team-decision-based RAST cohort with regard to morbidity, mortality und midterm outcomes.

METHOD

Between August 27nd 2013 and December 13th 2022 a total of 341 consecutive patients underwent isolated RAST. Baseline characteristics, operative variables, postoperative outcomes and follow-up information was collected from our medical database and by contacting all patients by phone.

RESULTS

Mean age was 64.5+/-10 years, median Euroscore II was 1.04 +/- 0.5. The predominant type of aortic disease was stenosis. Thirty-day mortality was 0.58% and there were two strokes (0.62%).Mean follow up time was 2.5 years with up to 9 years. At 1 and 5 years, survival was 99.3 % and 98.7% respectively.

CONCLUSION

In our specialized structural heart-team center with patient tailoreddecision-making, we are able tooffer RAST with an in-hospital mortality below 1%, low morbidity, need for reoperation and favourablemid-term survival.RAST might soon become the onlyacceptable surgical treatment optionin the era of interventionalprocedures and these excellentresults should serve as benchmarkfor the implementation of new interventions, specially in youngerand low-risk patient populations.